Gynaecological problems

Question 1

How should the increased risk of endometrial hyperplasia in PCOS be managed?

Answer 1

Progestogens should be used to induce a withdrawal bleed at least every 3-4 months

Question 1

How should women with PCOS be screened for T2DM?

Answer 1

If they have both PCOS and are overweight or have PCOS plus additional risk factors, they should be offered an OGTT

Question 2

What is the link between PCOS and both breast and ovarian cancers?

Answer 2

There does not appear to be an association between PCOS and breast and ovarian cancer

Question 3

What are the Rotterdam criteria for diagnosis of PCOS?

Answer 3

1. polycystic ovaries with either 12 or more follicles, or ovarian volume >10cm
2. Oligo-ovulation or anovulation
3. Clinical and/or biochemical signs of hyperandrogenism

Question 4

How can CAH be investigated for in rapidly progressing hirsuitism?

Answer 4

17-Hydroxyprogesterone is measured in the follicular phase and will be raised in CAH

Question 5

If 17-hydroxyprogesterone is borderline, which test is used to confirm diagnosis of CAH?

Answer 5

ACTH stimulation test

Question 6

What is the incidence of symptomatic ovarian cysts in premenopausal women being malignant?

Answer 6

1:1,000

Question 7

What percentage of suspected ovarian masses are ultimately found to be non-ovarian in origin?

Answer 7

10%

Question 8

What is the management of a simple ovarian cyst <50mm in a pre-menopausal woman?

Answer 8

Conservative: the majority will resolve over 2-3 menstrual cycles without intervention

Question 9

What is the role of LDH, afp and hCG measurement in evaluation of cysts in pre-menopausal women?

Answer 9

Should be undertaken for all women under 40 with complex ovarian mass due to the risk of germ cell tumours

Question 10

CA125 is primarily a marker for which ovarian cancer?

Answer 10

Epithelial ovarian carcinoma

Question 11

Which scoring system does GTG advocate for assessing risk of malignancy and how is it calculated?

Answer 11

RMI 1:
RMI = U x M x CA125

1 point for premenopausal, 3 points for postmenopausal
1 point for ultrasound score 1, 3 points for ultrasound score 2-5

Question 12

What are the sensitivity and specificity of using RMI 200 as a cut off for malignancy?

Answer 12

Sensitivity 78%
Specificity 87%

Question 13

What are the sensitivity and specificity of using IOTA rules for classifying masses as benign or malignant?

Answer 13

Sensitivity 95%
Specificity 91%

Question 14

What are the M-rules for IOTA classification?

Answer 14

Irregular solid tumour
Ascites
At least 4 papillary structures
Irregular multilocular solid tumour with largest diameter >=100mm
very strong blood flow

Question 15

How should premenopausal women with simple cysts of 50-70mm be managed?

Answer 15

With yearly followup ultrasound

Question 16

How should premenopausal women with simple cysts >70mm be managed?

Answer 16

Either MRI or surgical management

Question 17

How should women with a cyst growing between interval scans be managed?

Answer 17

RMI score followed by operative management

Question 18

What is the effect of COCP on functional ovarian cysts?

Answer 18

COCP does not promote the resolution of functional ovarian cysts

Question 19

What is the range of recurrence rate for ovarian cysts following needle aspiration?

Answer 19

Between 53-84%